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2.05 Corneal Foreign Body


Presentation

The eye has been struck by a falling or blowing particle, often a fleck of rust while working under a car, or a loose foreign body has become embedded by rubbing, thereby producing intense pain. Moderate to high-velocity foreign bodies (fragments chipped off a chisel by a hammer or spray from a grinding wheel) can be superficially embedded or lodged deep in the vitreous. Superficial foreign bodies may be visible during simple sidelighting of the cornea or by slit lamp examination. Deep foreign bodies may be visible only as moving shadows on funduscopy, with a trivial-appearing or invisible puncture in the sclera.

What to do:

What not to do:

Discussion

Decide beforehand how much time you will spend (and how much trauma you will inflict on the cornea) before giving up on removing a corneal foreign body and calling your ophthalmologic consultant. Some emergency physicians recommend using a small needle for scraping, to minimize the possibility of a corneal perforation, but with a tangential approach the larger needle is less likely to cause harm..

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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
Jon Handler, MD
Michael Gillam, MD